[Federal Register Volume 60, Number 169 (Thursday, August 31, 1995)]
[Notices]
[Pages 45517-45519]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-21590]



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DEPARTMENT OF VETERANS AFFAIRS

Information Collections Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Veterans Health Administration (VHA), Department of Veterans 
Affairs, has submitted to the Office of Management and Budget (OMB) the 
following proposals for the collection of information under the 
provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35).

OMB Number: 2900-0083.
Title and Form Number: Blood Donor Registration, VA Form 10-2420.
Type of Information Collection: Reinstatement, with change, of a 
previously approved collection for which approval has expired.
Needs and Uses: The information is used to determine if a prospective 
volunteer blood donor is free from illnesses that might case harm to a 
VA patient if transfused with the donor's blood.
Affected Public: Individuals or households.
Estimated Annual Burden: 6,000 hours.
Estimated Average Burden Per Respondent: 10 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 36,000 respondents.

OMB Number: 2900-0188.
Titles: Prescription, Authorization, Application, Procurement, Repair 
and Loan of Prosthetic Items.
Form Numbers:
    a. VA Form Letter 10--426, Loan Follow-up Letter.
    b. VA Form 10-2421; Prosthetic Authorization for Items or Services.
    c. VA Form 10-2914; Prescription and Authorization for Eyeglasses.
    d. VA Form 10-2520; Prosthetic Service Card Invoice.
    e. VA Form Letter 10-90, Request to Submit Estimate.
    f. Form Letter 10-1394, Application for Adaptive Equipment Motor 
Vehicle.
Type of Information Collection: Reinstatement, without change, of a 
previously approved collection for which approval has expired.
Needs and Uses: The forms and form letters are used to determine 
eligibility, prescribe, and authorize 

[[Page 45518]]
prosthetic devices; obtain repair estimates and allow for the direct 
purchase of prosthetic devices; and obtain follow-up information on 
loaned items.
Affected Public: Business or other for-profit--Individuals or 
households.
Estimated Annual Burden: 36,496 total hours.
    a. VA Form Letter 10-426--242 hours.
    b. VA Form 10-2421--16,667 hours.
    c. VA Form 10-2914--11,667 hours.
    d. VA Form 10-2520--3,334 hours.
    e. VA Form Letter 10-90--1,875 hours.
    f. VA Form Letter 10-1394--2,711 hours.
Estimated Average Burden Per Respondent:
    a. VA Form Letter 10-426--1 minute.
    b. VA Form 10-2421--4 minutes.
    c. VA Form 10-2914--4 minutes.
    d. VA Form 10-2520--5 minutes.
    e. VA Form Letter 10-9--5 minutes.
    f. VA Form Letter 10-1394--15 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 512,844 total respondents.
    a. VA Form Letter 10-426--14,500 respondents.
    b. VA Form 10-2421--250,000 respondents.
    c. VA Form 10-2914--175,000 respondents.
    d. VA Form 10-2520--40 respondents.
    e. VA Form Letter 10-9--22,500 respondents.
    f. VA Form Letter 10-1394--10,844 respondents.

OMB Number: 2900-0205.
Title: Application for Employment and Appraisal of Applicant for Title 
38 Positions.
Form Numbers:
    a. VA Form 10-2850, Application for Physicians, Dentists, and 
Optometrists.
    b. VA Form 10-2850a, Application for Nurses and Nurse Anesthetists.
    c. VA Form 10-2850b, Application for Residency.
    d. VA Form 10-2850c, Application for Associated Health Occupations 
Appointments.
    e. VA Form Letter 10-341a, Appraisal of Applicant.
Types of Information Collection: Reinstatement, without change, of a 
previously approved collection for which approval has expired.
Needs and Uses: The forms are completed by individuals applying for 
Title 38 position. VA Form Letter 10-341a is sent to educational 
institutions, organizations and individuals indicated by the applicant 
on the employment application form to elicit prior education and/or 
performance information. The information provided to VHA is used to 
determine eligibility for employment, and the appropriate grade and 
step rate.
Affected Public: Individuals or households--Business or other for-
profit--Not-for-profit institutions--State, Local or Tribal Government.
Estimated Annual Burden: 68,630 hours.
Estimated Average Burden Per Respondent:
    a. VA Form 10-2850--30 minutes.
    b. VA Form 10-2850a--30 minutes.
    c. VA Form 10-2850b--30 minutes.
    d. VA Form 10-2850c--30 minutes.
    e. VA Form Letter 10-341a--20 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 150,700 total respondents.
    a. VA Form 10-2850--12,900 respondents.
    b. VA Form 10-2850a--51,600 respondents.
    c. VA Form 10-2850b--27,000 respondents.
    d. VA Form 10-2850c--17,200 respondents.
    e. VA Form Letter 10341a--42,500 respondents.

OMB Number: 2900-0227
Title: Customer Feedback Surveys.
Form Numbers:
    a. VA Form 10-0142B, Prosthetic Patient Satisfaction Survey.
    b. VA Form 10-0142C, Semiannual Prosthetic Patient Satisfaction 
Program Report.
    c. VA Form 10-1465 (series), The customer Feedback Survey.
    d. VA Form 10-5387, Dietetic Service Survey.
Type of Information Collection: Extension of a currently approved 
collection.
Needs and Uses: These surveys evaluate VA patient's satisfaction with 
the health care they receive. The information will be used by VHA to 
assure that VA maintains a high level of care to the nation's veterans.
Affected Public: Individuals or households.
Estimated Annual Burden: 58,634 total hours.
    a. VA Form 10-0142 (Series)--1,557 hours.
    b. VA Form 10-1465 (Series)--52,490 hours.
    c. VA Form 10-5387--4,587 hours.
Estimated Average Burden Per Respondent:
    a. VA Form 10-0142 (Series)--3 minutes.
    b. VA Form 10-1465 (Series)--15 minutes.
    c. VA Form 10-5387--2 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 378,706 total respondents.
    a. VA Form 10-0142 (Series)--31,146 respondents.
    b. VA Form 10-1465 (Series)--209,960 respondents.
    c. VA Form 10-5387--137,600 respondents.

OMB Number: 2900-0529
Title and Form Number: Study of Reproductive Health Outcomes Among 
Women Vietnam Veterans, VA Form 10-20992(NR).
Type of Information Collection: Reinstatement, without change, of a 
previously approved collection for which approval has expired.
Needs and Uses: The purpose of the study is to determine the 
association of military service in Vietnam with any adverse 
reproductive health outcomes. The reproductive outcomes to be studied 
are infertility, spontaneous abortions, still births, congenital 
anomalies, neonatal death, birth weights, pre-term deliveries and 
number of children. In addition, the relative risk malignant tumors in 
female reproductive organs will be evaluated.
Affected Public: Individuals or households.
Estimated Annual Burden: 5,667 hours.
Estimated Average Burden Per Respondent: 50 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 6,800 respondents.

OMB Number: 2900-0554
Title and Form Number: Application and Evaluation for VA Homeless 
Providers Grants and Per Diem Program, VA Form 10-0362(Series).
Type of Information Collection: Revision of a currently approved 
collection.
Needs and Uses: The forms will be used by public and non-profit 
entities to apply for Federal aid to establish supportive services or 
supportive housing programs that benefit homeless veterans. The 
information will be used by VA to determine the most qualified to 
receive grant payments and to evaluate the program.
Affected Public: State, Local or Tribal Governments--Not-for-profit 
institutions.
Estimated Annual Burden: 63,654 hours.
Estimated Average Burden Per Respondent: 50 hours.
Frequency of Response: On occasion.

[[Page 45519]]

Estimated Number of Respondents: 4,235 respondents.

ADDRESSES: Copies of these submissions may be obtained from Ann 
Bickoff, Veterans Health Administration (161B4), Department of Veterans 
Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 565-7407.
    Comments and recommendations concerning the submissions should be 
directed to VA's OMB Desk Officer, Allison Eydt, OMB Human Resources 
and Housing Branch, New Executive Office Building, Room 10235, 
Washington, DC 20503 (202) 395-4650. Do not send requests for benefits 
to this address.

DATES: Comments on the information collections should be directed to 
the OMB Desk Officer within 30 days of this notice.

FOR FURTHER INFORMATION CONTACT: Ron Taylor, VA Clearance Officer 
(045A4), (202) 565-4412.

    Dated: August 21, 1995.

    By direction of the Secretary.
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 95-21590 Filed 8-30-95; 8:45 am]
BILLING CODE 8320-01-M